Sara Lister, Head of Pastoral Care, Psychological Support, and PALS, The Royal Marsden Hospital NHS Foundation Trust, UK.

Justine Hofland, Divisional Clinical Nurse Director - Cancer Services, The Royal Marsden NHS Foundation Trust, UK.

Brief table of contents v

Foreword to the tenth edition xv

Preface xvii

Acknowledgements xix

List of contributors xxi

Quick reference to the procedure guidelines xxv

How to use your manual xxix

1 The context of nursing 1

Overview 2

Background 2

Context of nursing 2

Evidence-based practice 7

Structure of the manual 8

Structure of the chapters 9

Finally 9

References 10

Part One Managing the patient journey 13

2 Admissions and assessment 14

Overview 16

Inpatient assessment and the process of care 16

Observation 24

Physical assessment 24

3 Discharge care and planning 45

Overview 46

Discharge care and planning 46

Discharging patients from hospital: internal procedures 47

Interface between primary and secondary care: external processes 53

Informal carers 58

The role of voluntary services 62

References 62

4 Infection prevention and control 64

Overview 66

Infection prevention and control 66

Hand hygiene 75

Personal protective equipment (PPE) 87

Specific patient-related procedures 101

Isolation procedures 105

Environmental hygiene and the management of waste in the healthcare environment 111

Prevention and management of inoculation injury 118

Websites 119

References 119

4.1 Hand washing 79

4.2 Hand decontamination using an alcohol-based handrub 80

4.3 Surgical scrub technique using soap and water 82

4.4 Surgical scrub technique using an alcohol-based handrub 84

4.5 Putting on and removing non-sterile gloves 88

4.6 Applying and removing a disposable apron 89

4.7 Putting on and removing a disposable mask or respirator 91

4.8 Putting on or removing goggles or a face-shield 93

4.9 Donning a sterile gown and gloves: closed technique 94

4.10 Donning sterile gloves: open technique 98

4.11 Aseptic technique example: changing a wound dressing 102

4.12 Source isolation: preparing an isolation room 106

4.13 Source isolation: entering an isolation room 107

4.14 Source isolation: leaving an isolation room 108

4.15 Source isolation: transporting infected patients outside a source isolation area 108

4.16 Protective isolation: preparing an isolation room 109

4.17 Protective isolation: entering an isolation room 110

4.18 Cleaning a hard surface without recontamination 112

4.19 Safe disposal of foul, infected or infested linen 117

Part Two Supporting patients with human functioning 123

5 Communication, psychological wellbeing and safeguarding 124

Overview 126

Communication 126

Providing information and making shared decisions 138

Communicating with specific populations 141

Psychological wellbeing 147

Safeguarding, mental capacity and the Mental Health Act 169

Websites 187

References 187

6 Elimination 194

Overview 196

Normal elimination 196

Altered urinary elimination 200

Altered faecal elimination 237

Stoma care 257

Websites 272

References 272

6.1 Slipper bedpan use: assisting a patient 198

6.2 Commode use: assisting a patient 199

6.3 Penile sheath application 202

6.4 Urinary catheterization: male 208

6.5 Urinary catheterization: female 210

6.6 Changing a suprapubic catheter 214

6.7 Urinary catheterization: intermittent self-catheterization patient guidance: male 216

6.8 Urinary catheterization: intermittent self-catheterization patient guidance: female 217

6.9 Urinary catheter bag: emptying 219

6.10 Urinary catheter removal 219

6.11 Commencing bladder irrigation 223

6.12 Nephrostomy tube: weekly dressing and bag change and sample collection 227

6.13 Nephrostomy tube: flushing technique 229

6.14 Nephrostomy tube: removal of locking pigtail drainage system 230

6.15 Flushing externalized ureteric stents 232

6.16 Removal of externalized ureteric stents 233

6.17 Continent urinary diversion stoma: self-catheterization 236

6.18 Insertion of a faecal management system 240

6.19 Insertion of a nasogastric drainage tube 247

6.20 Removal of a nasogastric drainage tube 249

6.21 Enema administration 250

6.22 Suppository administration 252

6.23 Digital rectal examination 254

6.24 Digital removal of faeces 256

6.25 Stoma siting 263

6.26 Stoma bag change 264

6.27 Obtaining a clean-catch urine sample from an ileal conduit 265

6.28 Stoma bridge or rod removal 266

7 Moving and positioning 278

Overview 280

Moving and positioning: general principles 280

Moving and positioning an unconscious patient 293

Moving and positioning a patient with an artificial airway 294

Moving and positioning a patient with respiratory compromise 298

Moving and positioning a patient with neurological impairment 301

Moving and positioning a patient with actual or suspected spinal cord compression or spinal cord injury 313

Moving and positioning a patient with raised intracranial pressure 325

Moving and positioning a patient with an amputation 326

Websites 329

References 329

7.1 Positioning a patient: supine 284

7.2 Positioning a patient: sitting up in bed 285

7.3 Positioning a patient: side-lying 286

7.4 Positioning a patient: lying down to sitting up 288

7.5 Moving a patient from sitting to standing: assisting the patient 289

7.6 Positioning a patient: in a chair or wheelchair 291

7.7 Assisting a patient to walk 292

7.8 Positioning an unconscious patient or a patient with an artificial airway in supine 295

7.9 Positioning an unconscious patient or a patient with an artificial airway in side-lying 296

7.10 Positioning a neurological patient with tonal problems in bed 309

7.11 Positioning a neurological patient with tonal problems in a chair 312

7.12 Application of a two-piece cervical collar 318

7.13 Log rolling a patient with suspected or confirmed cervical spinal instability (above T6) 319

7.14 Log rolling a patient with suspected or confirmed thoracolumbar spinal instability (T7 and below) 321

7.15 Early mobilization of a patient with spinal considerations 323

7.16 Positioning a patient with an amputation 327

8 Nutrition and fluid balance 334

Overview 336

Fluid balance 336

Nutritional status 351

Provision of nutritional support: Oral 359

Nutritional management of patients with dysphagia 364

Enteral tube feeding 365

Parenteral nutrition 385

Websites 389

References 389

8.1 Fluid input: measurement 345

8.2 Fluid output: monitoring/measuring output if the patient is catheterized 346

8.3 Fluid output: monitoring/measuring output if the patient is not catheterized 347

8.4 Fluid output: monitoring/measuring output from drains 347

8.5 Fluid output: monitoring/measuring output from gastric outlets, nasogastric tubes or gastrostomy 348

8.6 Fluid output: monitoring/measuring output from bowels 349

8.7 Fluid output: monitoring/measuring output from stoma sites 349

8.8 Measuring the weight and height of a patient 356

8.9 Feeding an adult patient 362

8.10 Nasogastric intubation with tubes using an internal guidewire or stylet 369

8.11 Removal of a nasogastric tube 374

8.12 Percutaneous endoscopically placed gastrostomy (PEG) tube care 375

8.13 Radiologically inserted gastrostomy (RIG) tube care 376

8.14 Removal of T-fasteners 377

8.15 Changing the balloon water and checking the volume of a balloon gastrostomy 378

8.16 Jejunostomy feeding tube care including dressing change 379

8.17 Insertion of a silicone gastrostomy stoma plug 380

8.18 Enteral feeding tubes: administration of feed using an enteral feeding pump 381

8.19 Enteral feeding tubes: administration of medication 384

8.20 Enteral feeding tubes: unblocking 386

9 Patient comfort and supporting personal hygiene 394

Overview 396

Personal hygiene 396

Sleep promotion in a hospitalized patient 407

Patient environment 409

Eye care 413

Ear care 423

Mouth care 427

Websites 439

References 439

9.1 Bedbathing a patient 401

9.2 Washing a patient's hair in bed 403

9.3 Shaving the face: wet shave 405

9.4 Shaving the face: dry electric shaver 406

9.5 Making an unoccupied bed 410

9.6 Making an occupied bed 412

9.7 Eye swabbing 417

9.8 Eye irrigation 418

9.9 Artificial eye care: insertion 420

9.10 Artificial eye care: removal 420

9.11 Contact lens removal: hard lenses 421

9.12 Contact lens removal: soft lenses 422

9.13 Irrigation of the external auditory canal using an electronic irrigator 425

9.14 Mouth care 436

9.15 Mouth care for a patient with dentures 437

10 Pain assessment and management 446

Overview 448

Pain 448

Pain management 456

Regional analgesia: local anaesthetic nerve blocks and infusions 462

Epidural analgesia 469

Entonox administration 481

Non-pharmacological methods of managing pain 485

References 491

10.1 Pain assessment 455

10.2 Peripheral nerve catheter removal 464

10.3 Epidural sensory blockade: assessment 475

10.4 Epidural exit site dressing change 475